inHealth, Johns Hopkins Individualized Health Initiative, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Critical Care and Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Netw Open. 2020 Mar 2;3(3):e201074. doi: 10.1001/jamanetworkopen.2020.1074.
Promoting patient mobility during hospitalization is associated with improved outcomes and reduced risk of hospitalization-associated functional decline. Therefore, accurate measurement of mobility with high-information content data may be key to improved risk prediction models, identification of at-risk patients, and the development of interventions to improve outcomes. Remote monitoring enables measurement of multiple ambulation metrics incorporating both distance and speed.
To evaluate novel ambulation metrics in predicting 30-day readmission rates, discharge location, and length of stay using a real-time location system to continuously monitor the voluntary ambulations of postoperative cardiac surgery patients.
DESIGN, SETTING, AND PARTICIPANTS: This prognostic cohort study of the mobility of 100 patients after cardiac surgery in a progressive care unit at Johns Hopkins Hospital was performed using a real-time location system. Enrollment occurred between August 29, 2016, and April 4, 2018. Data analysis was performed from June 2018 to December 2019.
Outcome measures included 30-day readmission, discharge location, and length of stay. Digital records of all voluntary ambulations were created where each ambulation consisted of multiple segments defined by distance and speed. Ambulation profiles consisted of 19 parameters derived from the digital ambulation records.
A total of 100 patients (81 men [81%]; mean [SD] age, 63.1 [11.6] years) were evaluated. Distance and speed were recorded for more than 14 000 segments in 840 voluntary ambulations, corresponding to a total of 127.8 km (79.4 miles) using a real-time location system. Patient ambulation profiles were predictive of 30-day readmission (sensitivity, 86.7%; specificity, 88.2%; C statistic, 0.925 [95% CI, 0.836-1.000]), discharge to acute rehabilitation (sensitivity, 84.6%; specificity, 86.4%; C statistic, 0.930 [95% CI, 0.855-1.000]), and length of stay (correlation coefficient, 0.927).
Remote monitoring provides a high-information content description of mobility, incorporating elements of step count (ambulation distance and related parameters), gait speed (ambulation speed and related parameters), frequency of ambulation, and changes in parameters on successive ambulations. Ambulation profiles incorporating multiple aspects of mobility enables accurate prediction of clinically relevant outcomes.
促进住院患者的活动能力与改善结果和降低与住院相关的功能下降风险有关。因此，使用具有高信息量数据的移动能力进行准确测量可能是改善风险预测模型、识别高危患者以及开发改善结果的干预措施的关键。远程监测可以测量包含距离和速度的多种活动指标。
使用实时定位系统连续监测心脏手术后患者的自愿活动，评估新的活动指标在预测 30 天再入院率、出院地点和住院时间方面的作用。
设计、地点和参与者：这是一项在约翰霍普金斯医院渐进式护理病房对 100 例心脏手术后患者活动能力的预后队列研究，使用实时定位系统进行。登记时间为 2016 年 8 月 29 日至 2018 年 4 月 4 日。数据分析时间为 2018 年 6 月至 2019 年 12 月。
结局包括 30 天再入院、出院地点和住院时间。所有自愿活动都创建了数字记录，每个活动由距离和速度定义的多个片段组成。活动概况由从数字活动记录中派生的 19 个参数组成。
共评估了 100 例患者（81 例男性[81%]；平均[标准差]年龄为 63.1[11.6]岁）。在 840 次自愿活动中记录了超过 14000 个片段的距离和速度，使用实时定位系统共记录了 127.8 公里（79.4 英里）。患者的活动概况可预测 30 天再入院（敏感性，86.7%；特异性，88.2%；C 统计量，0.925[95%CI，0.836-1.000]）、出院至急性康复（敏感性，84.6%；特异性，86.4%；C 统计量，0.930[95%CI，0.855-1.000]）和住院时间（相关系数，0.927）。
远程监测提供了移动能力的高信息量描述，包含了步数（活动距离和相关参数）、步速（活动速度和相关参数）、活动频率以及连续活动中参数变化等元素。纳入移动能力多个方面的活动概况可准确预测临床相关结局。
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